UNASSIGNED: An updated summary of the research profile of nutrition for the last 30 years for decompensated cirrhosis is lacking. This study aimed to explore the literature on nutrition for decompensated cirrhosis, draw a visual network map to investigate the research trends, and provide suggestions for future research. The Web of Science database retrieves the literature on nutrition for decompensated cirrhosis between 1994 and 2024.
UNASSIGNED: We used the cooperative, co-occurrence, and co-citation networks in the CiteSpace knowledge graph analysis tool to explore and visualize the relevant countries, institutions, authors, co-cited journals, keywords, and co-cited references.
UNASSIGNED: We identified 741 articles on nutrition for decompensated cirrhosis. The number of publications and research interests has generally increased. The USA contributed the largest number of publications and had the highest centrality. The University of London ranked first in the number of articles issued, followed by the University of Alberta and Mayo Clinic. TANDON P, a \"core strength\" researcher, is a central hub in the collaborative network. Of the cited journals, HEPATOLOGY had the highest output (540, 15.3%).
UNASSIGNED: Over the past three decades, the focus of research on nutrition in decompensated cirrhosis has shifted from \"hepatic encephalopathy, intestinal failure, metabolic syndrome, and alcoholic hepatitis\" to \"sarcopenia and nutritional assessment.\" In the future, nutritional interventions for sarcopenia should be based on a multimodal approach to address various causative factors. Its targeted treatment is an emerging area that warrants further in-depth research.

OBJECTIVE: Malnutrition is prevalent among hospitalised patients, and increases the morbidity, mortality, and medical costs; yet nutritional assessments on admission are not routine. This study assessed the clinical and economic benefits of using an artificial intelligence (AI)-based rapid nutritional diagnostic system for routine nutritional screening of hospitalised patients.
METHODS: A nationwide multicentre randomised controlled trial was conducted at 11 centres in 10 provinces. Hospitalised patients were randomised to either receive an assessment using an AI-based rapid nutritional diagnostic system as part of routine care (experimental group), or not (control group). The overall medical resource costs were calculated for each participant and a decision-tree was generated based on an intention-to-treat analysis to analyse the cost-effectiveness of various treatment modalities. Subgroup analyses were performed according to clinical characteristics and a probabilistic sensitivity analysis was performed to evaluate the influence of parameter variations on the incremental cost-effectiveness ratio (ICER).
RESULTS: In total, 5763 patients participated in the study, 2830 in the experimental arm and 2933 in the control arm. The experimental arm had a significantly higher cure rate than the control arm (23.24% versus 20.18%; p = 0.005). The experimental arm incurred an incremental cost of 276.52 CNY, leading to an additional 3.06 cures, yielding an ICER of 90.37 CNY. Sensitivity analysis revealed that the decision-tree model was relatively stable.
CONCLUSIONS: The integration of the AI-based rapid nutritional diagnostic system into routine inpatient care substantially enhanced the cure rate among hospitalised patients and was cost-effective.
BACKGROUND: NCT04776070 (https://clinicaltrials.gov/study/NCT04776070).

OBJECTIVE: The use of indirect calorimetry to determine energy requirements is highly recommended in critically ill patients. To facilitate this a new and easy to use calorimeter (Q-NRG+, Cosmed) was developed. The primary aim of our study was to describe the usefulness of this calorimeter and, secondarily, to investigate the agreement between measured and predicted energy needs in a large cohort of critically ill adult patients.
METHODS: A prospective observational study was conducted among adult mechanically ventilated patients with COVID-19. Indirect calorimetry (Q-NRG+) to measure resting energy expenditure (mREE) was performed in the first week after admission and, wherever possible, repeated weekly. Reasons for not performing indirect calorimetry were reported. Parameters of indirect calorimetry and patient\'s conditions during the measurements were collected. Measurements were defined as valid if less than 10% overall variation in VO2 and VCO2 and respiratory quotient ranges between 0.67 and 1.1 were observed. mREE was compared with predictive REE (pREE) using standard formulas to explore hypo (<90%)-and hypermetabolism. (>110%). Bland-Altman method and two-way mixed intraclass correlation coefficients (ICC) (single measures) were used to assess the agreement between mREE and pREE.
RESULTS: Indirect calorimetric measurements were performed in 180 of the 432 admitted patients (42%). Of the 276 performed measurements 85% were valid, and of these 90% were used to tailor nutritional therapy. Most patients were male (71%), median age was 62 years [IQR 52; 70]. Logistical issues (absence of measuring staff, no device, no stock of disposables, MRSA isolation) and clinical issues (e.g Fio2>70%, detubated but still in ICU) were the main reasons for not performing indirect calorimetry. The majority of the REE-measurements indicated either hypo- or hypermetabolism (57% week 1 and 56% week 2). The correlation between mREE and pREE was very moderate (ICC = 0.527).
CONCLUSIONS: Although indirect calorimetry was performed in less than half of the patients, it proved to be of value to guide nutritional therapy. We conclude that the technique is easily applicable and expect that its impact can be significantly increased with the resolution of logistical and organizational issues.

The aims of this research were to evaluate the current nutritional status, dietary intake, and level of physical activity and assess the need for intervention. This was a cross-sectional study with 2724 participating children aged 6-9 years old. Nutritional status was assessed using nutrimetry, dietary intake with a 3-day food-recall questionnaire and physical activity with an ad hoc questionnaire. The nutricode with the highest prevalence was healthy weight/normal stature, with 51.3% of the sample. For the BMI for age Z-score, those in the overweight/obesity category represented 37.5% of the sample, while the thinness category included 7.6%. Intake of calories, proteins, sugar, lipids, SFA, MUFA, and cholesterol were significantly higher than recommended. The thinness groups consumed a significantly higher amount of excess calories while the overweight/obesity groups had the lowest mean excess calorie intake. Children in the thinness category presented the highest rates at both ends of the spectrum for sedentary activities. This study showed the high prevalence of malnutrition in schoolchildren. The results for the risk of thinness and overweight/obesity according to individual nutrient intake should be carefully interpreted. Lifestyle is a fundamental aspect to consider when combating malnutrition, especially at the level of dietary and physical activity habits, to combine various methods of intervention to improve nutritional status.

BACKGROUND: To assess habitual salt intake, tools are needed to measure 24-h urinary salt excretion repeatedly. We developed and validated a new portable salt monitor, which measures salt excreted per urination and sums the values to provide an accurate estimate of urinary salt excretion over 24 h.
METHODS: A previously developed salt monitor was improved with respect to the capacity, volume sensors, and equation for urinary sodium chloride concentration estimation. In 20 healthy Japanese female volunteers, 24-h urinary salt excretion was measured using the salt monitor and a conventional 24-h urine collection method on eight nonconsecutive days.
RESULTS: In a total of 157 days, there were no fixed or proportional errors between the methods. The mean salt intake over 8 days was 8.5 ± 2.0 g/day for the 24-h urine collection and 8.3 ± 2.3 g/day for the salt monitor, showing a strong correlation (r = 0.912, p < 0.001). At a cut-off value of 6 g, the salt monitor was able to completely classify individuals by habitual salt intake.
CONCLUSIONS: The validity of the new salt monitor was confirmed. The device can be considered an alternative to the traditional 24-h urine collection for repeated surveys and self-management of daily salt intake.

Malnutrition is a growing public health problem leading to increased morbidity and mortality worldwide. Up to 50% of elderly patients are hospitalized due to this condition. In this review, we focused on analyzing the current diagnostic criteria for malnutrition among the elderly population and proposing promising solutions. Currently used diagnostic methods such as BMI or serum albumin levels are not sufficient to indicate malnutrition, which is affected by many factors, including the number of chronic diseases, multiple medications taken, or physical condition. Moreover, current recommendations are inadequate because they fail to account for various factors such as chronic illnesses, multiple medications, and bodily changes that are crucial in diagnostic evaluations. There is a noticeable gap between these recommendations and actual clinical practice. Nevertheless, developing more precise, non-invasive biomarkers and personalized nutrition strategies has to be explored. One of these strategies we discuss in our review is multidisciplinary approaches that combine nutrition, physical activity, and psychosocial support. Addressing malnutrition among the elderly should rely on standardized protocols and personalized interventions to enhance their nutritional health and overall well-being.

OBJECTIVE: Correctly characterizing malnutrition is a challenge. Transthyretin (TTR) rapidly responds to adequate protein intake/infusion, which could be used as a marker to identify malnutrition. Nutritional therapy is used to prevent malnutrition. Parenteral nutrition (PN) requires daily monitoring to determine whether what is being offered is adequate. This article aims to investigate whether the practice of measuring TTR is justified.
METHODS: Data from patients admitted to the ward or intensive care unit (ICU) were collected at three different times: within the first 72 h (T1) of PN use, on the 7th day (T2), and the 14th day (T3) after the initial assessment.
RESULTS: 302 patients were included; the average age was 48.3 years old; the prevalence of death was 22.2%, and 61.6% of the sample were male. TTR values and the effectiveness of nutritional support in these patients were not associated with the outcome; however, meeting caloric needs was related to the outcome (p = 0.047). No association was found when TTR values were compared to the nutritional status. Thus, TTR was not a good indicator of nutritional risk or nutritional status in hospitalized patients.
CONCLUSIONS: Undoubtedly, the TTR measurement was inversely proportional to CRP measurements. It was possible to conclude in this follow-up cohort of hospitalized patients that TTR values were not useful for determining whether the patient was malnourished, predicting death or effectiveness of nutritional support, yet based upon our analyses, a decrease in TTR greater than 0.024 units for every 1 unit increase in CRP might be due to ineffective nutritional supply.

UNASSIGNED: Nutrition is a fundamental aspect of nursing care, however older people cared for in hospital, in a care home or in their own home do not always receive adequate support with their nutritional needs, which can leave them at risk of malnutrition. Using a holistic, biopsychosocial framework to support a comprehensive nutritional assessment that includes malnutrition screening can support the nurse to identify the older person\'s nutritional status and nutrition needs. Nurses undertaking this procedure must ensure they have the knowledge and skills to do so and work within the limits of their competence. • Malnutrition in older people can lead to a decline in functional ability, reduced muscle strength, fatigue, impaired immunity, suboptimal wound healing, increased risk of infection and increased risk of falls. • Screening for, and assessing the risk of, malnutrition is an important part of nursing assessments in any healthcare setting. • A holistic nutritional assessment should incorporate physiological, psychological, emotional, spiritual, social and cultural elements. REFLECTIVE ACTIVITY: \' How to\' articles can help to update your practice and ensure it remains evidence based. Apply this article to your practice. Reflect on and write a short account of: • How this article might improve your practice when undertaking a holistic nutritional assessment with an older person. • How you could use this information to educate nursing students or your colleagues on the appropriate techniques and evidence base for undertaking a holistic nutritional assessment with an older person.

BACKGROUND: Malnutrition is common in older atrial fibrillation (AF) patients and results in poor clinical outcomes. The Geriatric Nutritional Risk Index (GNRI) is a straightforward method for evaluating nutritional health. However, its prognostic value in AF patients is unclear. This research focused on examining the correlation between GNRI and overall mortality in Chinese individuals with AF.
METHODS: We performed a multicenter retrospective study at four Chinese hospitals involving patients diagnosed with AF between January 2019 and August 2023. Using GNRI, nutritional status was evaluated, classifying patients into three categories. Multivariable logistic regression and restricted cubic spline analysis assess the relationship between GNRI and mortality, with exploratory subgroup analyses investigating potential effect modifiers.
RESULTS: The study included 4,878 AF patients with a median follow-up of 19 months. The mean age was 71 (63-78), and the mean GNRI was 102 (95-108). Malnutrition was identified in 1,776 patients (36.41%). During the study, 419 (8.59%) deaths occurred. After controlling for confounders, moderate to severe malnutrition was linked to an increased risk of all-cause mortality compared to no malnutrition (odds ratio 1.50; 95% CI, 1.17-1.94). The relationship between GNRI and mortality risk was approximately linear, with consistent associations across subgroups.
CONCLUSIONS: Malnutrition, as assessed by GNRI, is prevalent among Chinese AF patients and is independently linked to higher all-cause mortality risk.

BACKGROUND: Dysphagia and malnutrition are major contributors to mortality in patients with acute stroke. An early assessment of nutritional status upon hospital admission is crucial to enhance clinical outcomes by reducing the associated high-risk complications. However, the fragmented nature of the existing literature makes it difficult to optimize clinical practices.
OBJECTIVE: This study aims to identify the best clinical practices that nurses and other healthcare professionals can employ for the immediate assessment of nutritional risk in patients diagnosed with acute stroke.
METHODS: Systematic review of clinical practice guidelines and systematic reviews.
METHODS: Comprehensive bibliographic searches were conducted up to May 2024 following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines across the databases Cochrane Library, PubMed, Embase, CINAHL, and Scopus, and three recognized guideline repositories.
METHODS: The quality of clinical practice guidelines was ascertained using the Appraisal of Guidelines for Research and Evaluation II (AGREE II) instrument, and the quality of systematic reviews was assessed through A MeaSurement Tool to Assess Systematic Reviews (AMSTAR 2). The evidence quality was appraised based on the classifications by the European Society of Cardiology.
RESULTS: Out of 2534 identified records, 15 were incorporated into this review. Predominantly, the selected clinical practice guidelines and systematic reviews exhibited high methodological quality. Notably, the Gugging Swallowing Screen and the Malnutrition Universal Screening Tool were pinpointed as primary tools for initial screenings. Most studies recommended that these assessments, ideally conducted within the first 24 h of patient admission, should be carried out by specially trained professionals, highlighting the pivotal role of nurses. Deviations in screening outcomes necessitate complementary specialist evaluations.
CONCLUSIONS: This systematic review offers a consolidation of current insights, proposing an innovative and integrated approach to assess nutritional needs of high-risk patients. It underscores the importance of nurses in the screening process, emphasizing their pivotal role in the nutritional management of patients with acute stroke, and advocates for further research endeavors to standardize intervention protocols to elevate patient clinical outcomes.
UNASSIGNED: PROSPERO CRD42023425140.