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Nutrition and Metabolism in Critical Care

A special issue of Nutrients (ISSN 2072-6643). This special issue belongs to the section "Nutrition and Metabolism".

Deadline for manuscript submissions: closed (31 October 2020) | Viewed by 37923

Special Issue Editor

Division of Endocrinology and Diabetology, Medical University of Graz, 8036 Graz, Austria
Interests: intensive care; endocrinology; vitamin D; hypoparathyroidism; iron deficiency; women in science
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Nutrition and metabolism are an essential part of critical care, in both routine and in research. All critically ill patients require nutrition and micronutrients to fight their acute illness. In recent years, many large trials have expanded our knowledge of clinical nutrition, but even more questions remain and need answers.

Nutrition consists of many components, including macronutrients such as proteins and micronutrients such as iron, selenium, thiamine, vitamin C, or vitamin D. Aside from logistic questions of when and how, it is unclear how large intraindividual differences in metabolism really are and how they may contribute to differences in clinical outcomes for patients after an acute insult like a stroke, myocardial infarction, major surgery, or sepsis.

This Special Issue aims to cover interesting and evolving topics covering all aspects of nutrition and metabolism in critical care.

Dr. Karin Amrein
Guest Editor

Manuscript Submission Information

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Keywords

  • nutrition
  • metabolism
  • critical care
  • micronutrients
  • vitamins
  • trace elements
  • parenteral nutrition
  • enteral nutrition

Published Papers (9 papers)

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Research

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14 pages, 1343 KiB  
Article
Hospital Malnutrition, Nutritional Risk Factors, and Elements of Nutritional Care in Europe: Comparison of Polish Results with All European Countries Participating in the nDay Survey
by Joanna Ostrowska, Isabella Sulz, Silvia Tarantino, Michael Hiesmayr and Dorota Szostak-Węgierek
Nutrients 2021, 13(1), 263; https://0-doi-org.brum.beds.ac.uk/10.3390/nu13010263 - 18 Jan 2021
Cited by 15 | Viewed by 4402
Abstract
NutritionDay (nDay) is a project established by the Medical University of Vienna and the European Society for Clinical Nutrition and Metabolism (ESPEN) to audit the nutritional status of hospitalized patients and nursing home residents. This study aimed to evaluate nDay data describing the [...] Read more.
NutritionDay (nDay) is a project established by the Medical University of Vienna and the European Society for Clinical Nutrition and Metabolism (ESPEN) to audit the nutritional status of hospitalized patients and nursing home residents. This study aimed to evaluate nDay data describing the prevalence of hospital malnutrition, nutritional risk factors, and elements of the nutritional care process implemented in hospital wards in 25 European countries and to compare the data derived from Poland with the data collected in all the European countries participating in the study. In total, 10,863 patients (European reference group: 10,863 participants including Poland: 498 participants) were involved in the study. The prevalence of malnutrition was identified on the basis of the ESPEN diagnostic criteria established in 2015, while the prevalence of nutritional risk factors was assessed by analyzing the following parameters: body mass index (BMI), score of Malnutrition Screening Tool (MST), recent weight loss, insufficient food intake, decreased appetite, increased number of drugs intake, reduced mobility, and poor self-reported health status. Malnutrition prevalence was 12.9% in patients from the European reference group and 9.4% in patients from Polish hospital wards (p < 0.05). However, the prevalence of some nutritional risk factors, i.e., recent weight loss, history of decreased food intake, and low actual food intake, were approximately four times more prevalent than diagnosed malnutrition (referring to approximately 40–50% of all participants). In comparison to the European reference group, the significant differences observed in Polish hospital wards concerned mainly dietitian’s involvement in the process of treating malnutrition (16% vs. 57.2%; p < 0.001); supply of special diets (8% vs. 16.1%; p < 0.0001); provision of oral nutritional support (ONS) (3.8% vs. 12.2%; p < 0.0001); prescription of enteral/parenteral nutrition therapy to hospitalized patients (8.2% vs. 11.7%; p < 0.001); as well as recording patient weight performed at hospital admission (100% vs. 72.9%; p < 0.0001), weekly (20% vs. 41.4%; p < 0.05), and occasionally (0% vs. 9.2%). These results indicate that the prevalence of malnutrition and malnutrition risk factors in hospitalized patients in Poland was slightly lower than in the European reference group. However, some elements of the nutritional care process in Polish hospitals were found insufficient and demand more attention. Full article
(This article belongs to the Special Issue Nutrition and Metabolism in Critical Care)
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12 pages, 469 KiB  
Article
Hypoalbuminemia on Admission as an Independent Risk Factor for Acute Functional Decline after Infection
by Hidehiko Nakano, Hideki Hashimoto, Masaki Mochizuki, Hiromu Naraba, Yuji Takahashi, Tomohiro Sonoo and Kensuke Nakamura
Nutrients 2021, 13(1), 26; https://0-doi-org.brum.beds.ac.uk/10.3390/nu13010026 - 23 Dec 2020
Cited by 4 | Viewed by 2646
Abstract
The risk of acute functional decline increases with age, and concepts including frailty and post-acute care syndrome have been proposed; however, the effects of the nutritional status currently remain unclear. Patients admitted to the emergency department of Hitachi General Hospital for infectious diseases [...] Read more.
The risk of acute functional decline increases with age, and concepts including frailty and post-acute care syndrome have been proposed; however, the effects of the nutritional status currently remain unclear. Patients admitted to the emergency department of Hitachi General Hospital for infectious diseases between April 2018 and May 2019 were included. To identify risk factors for functional decline at discharge, defined as Barthel Index <60, we investigated basic characteristics, such as age, sex, disease severity, the pre-morbid care status, and cognitive impairment, as well as laboratory data on admission, including albumin as a nutritional assessment indicator. In total, 460 surviving patients out of 610 hospitalized for infection were analyzed. In a multivariable logistic regression analysis, factors independently associated with Barthel Index <60 at discharge were age (adjusted OR 1.03, 95%CI 1.01–1.06, p = 0.022), serum albumin (adjusted OR: 0.63, 95%CI: 0.41–0.99, p = 0.043), and the need for care prior to admission (adjusted OR: 5.92, 95%CI: 3.15–11.15, p < 0.001). Hypoalbuminemia on admission in addition to age and the need for care prior to admission were identified as risk factors for functional decline in patients hospitalized for infection. Functional decline did not correlate with the severity of illness. Full article
(This article belongs to the Special Issue Nutrition and Metabolism in Critical Care)
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13 pages, 253 KiB  
Article
Prevalence and Impact of Vitamin D Deficiency in Critically Ill Cancer Patients Admitted to the Intensive Care Unit
by Nina Buchtele, Elisabeth Lobmeyr, Julia Cserna, Christian Zauner, Gottfried Heinz, Gürkan Sengölge, Wolfgang R. Sperr, Thomas Staudinger, Peter Schellongowski and Philipp Wohlfarth
Nutrients 2021, 13(1), 22; https://0-doi-org.brum.beds.ac.uk/10.3390/nu13010022 - 23 Dec 2020
Cited by 5 | Viewed by 3560
Abstract
Vitamin D deficiency is frequent in cancer patients and a risk factor for morbidity and mortality during critical illness. This single-center retrospective study analyzed 25-hydroxyvitamin D levels in critically ill cancer patients (n = 178; hematologic, n = 108; solid, n = 70) [...] Read more.
Vitamin D deficiency is frequent in cancer patients and a risk factor for morbidity and mortality during critical illness. This single-center retrospective study analyzed 25-hydroxyvitamin D levels in critically ill cancer patients (n = 178; hematologic, n = 108; solid, n = 70) enrolled in a prospective ICU registry. The primary analysis was the prevalence of vitamin D deficiency (<20 ng/mL) and the severe deficiency (≤12 ng/mL). Secondary analyses included risk factors for vitamin D deficiency and its impact on ICU, hospital, and 1-year mortality. The prevalence of vitamin D deficiency and severe deficiency was 74% (95% CI: 67–80%) and 54% (95% CI: 47–61%). Younger age, relapsed/refractory disease, and a higher sepsis-related organ failure assessment (SOFA) score were independent risk factors for vitamin D deficiency (p < 0.05). After adjusting for relapsed/refractory disease, infection, the SOFA score, and the early need for life-supporting interventions, severe vitamin D deficiency was an independent predictor of hospital mortality (OR: 2.21, 95% CI: 1.03–4.72, p = 0.04) and 1-year mortality (OR: 3.40, 95% CI: 1.50–7.71, p < 0.01), but not of ICU mortality. Conclusion: Vitamin D deficiency is common in critically ill cancer patients requiring ICU admission, but its impact on short-term mortality in this group is uncertain. The observed association of severe vitamin D deficiency with the post-ICU outcome warrants clinical consideration and further study. Full article
(This article belongs to the Special Issue Nutrition and Metabolism in Critical Care)
27 pages, 2749 KiB  
Article
Secondary Sclerosing Cholangitis in Critically Ill Patients Alters the Gut–Liver Axis: A Case Control Study
by Andreas Blesl, Christoph Jüngst, Frank Lammert, Günter Fauler, Florian Rainer, Bettina Leber, Nicole Feldbacher, Silvia Stromberger, Renate Wildburger, Walter Spindelböck, Peter Fickert, Angela Horvath and Vanessa Stadlbauer
Nutrients 2020, 12(9), 2728; https://0-doi-org.brum.beds.ac.uk/10.3390/nu12092728 - 07 Sep 2020
Cited by 6 | Viewed by 2720
Abstract
Secondary sclerosing cholangitis in critically ill patients (SC-CIP) occurs after long-term intensive care treatment. This study aimed to assess the gut–liver axis in SC-CIP. Stool microbiome composition, gut permeability, bacterial translocation and serum bile acid profiles of 18 SC-CIP patients compared to 11 [...] Read more.
Secondary sclerosing cholangitis in critically ill patients (SC-CIP) occurs after long-term intensive care treatment. This study aimed to assess the gut–liver axis in SC-CIP. Stool microbiome composition, gut permeability, bacterial translocation and serum bile acid profiles of 18 SC-CIP patients compared to 11 patients after critical illness without liver disease (CIP controls), 21 patients with cirrhosis and 21 healthy controls were studied. 16S rDNA was isolated from stool and sequenced using the Illumina technique. Diamine oxidase, zonulin, soluble CD14 (sCD14) and lipopolysaccharide binding protein were measured in serum and calprotectin in stool. Serum bile acids were analyzed by high-performance liquid chromatography-mass spectrometry (HPLC-MS). Reduced microbiome alpha diversity and altered beta diversity were seen in SC-CIP, CIP controls and cirrhosis compared to healthy controls. SC-CIP patients showed a shift towards pathogenic taxa and an oralization. SC-CIP, CIP controls and cirrhotic patients presented with impaired gut permeability, and biomarkers of bacterial translocation were increased in SC-CIP and cirrhosis. Total serum bile acids were elevated in SC-CIP and cirrhosis and the bile acid profile was altered in SC-CIP, CIP controls and cirrhosis. In conclusions, observed alterations of the gut–liver axis in SC-CIP cannot solely be attributed to liver disease, but may also be secondary to long-term intensive care treatment. Full article
(This article belongs to the Special Issue Nutrition and Metabolism in Critical Care)
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Review

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17 pages, 1674 KiB  
Review
Endocrine Challenges in Patients with Continuous-Flow Left Ventricular Assist Devices
by Gennaro Martucci, Federico Pappalardo, Harikesh Subramanian, Giulia Ingoglia, Elena Conoscenti and Antonio Arcadipane
Nutrients 2021, 13(3), 861; https://0-doi-org.brum.beds.ac.uk/10.3390/nu13030861 - 05 Mar 2021
Cited by 1 | Viewed by 2395
Abstract
Heart failure (HF) remains a leading cause of morbidity, hospitalization, and mortality worldwide. Advancement of mechanical circulatory support technology has led to the use of continuous-flow left ventricular assist devices (LVADs), reducing hospitalizations, and improving quality of life and outcomes in advanced HF. [...] Read more.
Heart failure (HF) remains a leading cause of morbidity, hospitalization, and mortality worldwide. Advancement of mechanical circulatory support technology has led to the use of continuous-flow left ventricular assist devices (LVADs), reducing hospitalizations, and improving quality of life and outcomes in advanced HF. Recent studies have highlighted how metabolic and endocrine dysfunction may be a consequence of, or associated with, HF, and may represent a novel (still neglected) therapeutic target in the treatment of HF. On the other hand, it is not clear whether LVAD support, may impact the outcome by also improving organ perfusion as well as improving the neuro-hormonal state of the patients, reducing the endocrine dysfunction. Moreover, endocrine function is likely a major determinant of human homeostasis, and is a key issue in the recovery from critical illness. Care of the endocrine function may contribute to improving cardiac contractility, immune function, as well as infection control, and rehabilitation during and after a LVAD placement. In this review, data on endocrine challenges in patients carrying an LVAD are gathered to highlight pathophysiological states relevant to this setting of patients, and to summarize the current therapeutic suggestions in the treatment of thyroid dysfunction, and vitamin D, erythropoietin and testosterone administration. Full article
(This article belongs to the Special Issue Nutrition and Metabolism in Critical Care)
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31 pages, 611 KiB  
Review
Risks in Management of Enteral Nutrition in Intensive Care Units: A Literature Review and Narrative Synthesis
by Magdalena Hoffmann, Christine Maria Schwarz, Stefan Fürst, Christina Starchl, Elisabeth Lobmeyr, Gerald Sendlhofer and Marie-Madlen Jeitziner
Nutrients 2021, 13(1), 82; https://0-doi-org.brum.beds.ac.uk/10.3390/nu13010082 - 29 Dec 2020
Cited by 14 | Viewed by 6799
Abstract
Critically ill patients in the intensive care unit (ICU) have a high risk of developing malnutrition, and this is associated with poorer clinical outcomes. In clinical practice, nutrition, including enteral nutrition (EN), is often not prioritized. Resulting from this, risks and safety issues [...] Read more.
Critically ill patients in the intensive care unit (ICU) have a high risk of developing malnutrition, and this is associated with poorer clinical outcomes. In clinical practice, nutrition, including enteral nutrition (EN), is often not prioritized. Resulting from this, risks and safety issues for patients and healthcare professionals can emerge. The aim of this literature review, inspired by the Rapid Review Guidebook by Dobbins, 2017, was to identify risks and safety issues for patient safety in the management of EN in critically ill patients in the ICU. Three databases were used to identify studies between 2009 and 2020. We assessed 3495 studies for eligibility and included 62 in our narrative synthesis. Several risks and problems were identified: No use of clinical assessment or screening nutrition assessment, inadequate tube management, missing energy target, missing a nutritionist, bad hygiene and handling, wrong time management and speed, nutritional interruptions, wrong body position, gastrointestinal complication and infections, missing or not using guidelines, understaffing, and lack of education. Raising awareness of these risks is a central aspect in patient safety in ICU. Clinical experts can use a checklist with 12 identified top risks and the recommendations drawn up to carry out their own risk analysis in clinical practice. Full article
(This article belongs to the Special Issue Nutrition and Metabolism in Critical Care)
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11 pages, 252 KiB  
Review
Trial Design in Critical Care Nutrition: The Past, Present and Future
by Lee-anne S. Chapple, Emma J. Ridley and Marianne J. Chapman
Nutrients 2020, 12(12), 3694; https://0-doi-org.brum.beds.ac.uk/10.3390/nu12123694 - 30 Nov 2020
Cited by 12 | Viewed by 2743
Abstract
The specialty of nutrition in critical care is relatively modern, and accordingly, trial design has progressed over recent decades. In the past, small observational and physiological studies evolved to become small single-centre comparative trials, but these had significant limitations by today’s standards. Power [...] Read more.
The specialty of nutrition in critical care is relatively modern, and accordingly, trial design has progressed over recent decades. In the past, small observational and physiological studies evolved to become small single-centre comparative trials, but these had significant limitations by today’s standards. Power calculations were often not undertaken, outcomes were not specified a priori, and blinding and randomisation were not always rigorous. These trials have been superseded by larger, more carefully designed and conducted multi-centre trials. Progress in trial conduct has been facilitated by a greater understanding of statistical concepts and methodological design. In addition, larger numbers of potential study participants and increased access to funding support trials able to detect smaller differences in outcomes. This narrative review outlines why critical care nutrition research is unique and includes a historical critique of trial design to provide readers with an understanding of how and why things have changed. This review focuses on study methodology, population group, intervention, and outcomes, with a discussion as to how these factors have evolved, and concludes with an insight into what we believe trial design may look like in the future. This will provide perspective on the translation of the critical care nutrition literature into clinical practice. Full article
(This article belongs to the Special Issue Nutrition and Metabolism in Critical Care)
16 pages, 864 KiB  
Review
Oral Nutrition during and after Critical Illness: SPICES for Quality of Care!
by Marjorie Fadeur, Jean-Charles Preiser, Anne-Marie Verbrugge, Benoit Misset and Anne-Françoise Rousseau
Nutrients 2020, 12(11), 3509; https://0-doi-org.brum.beds.ac.uk/10.3390/nu12113509 - 14 Nov 2020
Cited by 11 | Viewed by 4144
Abstract
Malnutrition is associated to poor outcomes in critically ill patients. Oral nutrition is the route of feeding in less than half of the patients during the intensive care unit (ICU) stay and in the majority of ICU survivors. There are growing data indicating [...] Read more.
Malnutrition is associated to poor outcomes in critically ill patients. Oral nutrition is the route of feeding in less than half of the patients during the intensive care unit (ICU) stay and in the majority of ICU survivors. There are growing data indicating that insufficient and/or inadequate intakes in macronutrients and micronutrients are prevalent within these populations. The present narrative review focuses on barriers to food intakes and considers the different points that should be addressed in order to optimize oral intakes, both during and after ICU stay. They are gathered in the SPICES concept, which should help ICU teams improve the quality of nutrition care following 5 themes: swallowing disorders screening and management, patient global status overview, involvement of dieticians and nutritionists, clinical evaluation of nutritional intakes and outcomes, and finally, supplementation in macro-or micronutrients. Full article
(This article belongs to the Special Issue Nutrition and Metabolism in Critical Care)
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16 pages, 979 KiB  
Review
Effect of Supplemental Parenteral Nutrition Versus Enteral Nutrition Alone on Clinical Outcomes in Critically Ill Adult Patients: A Systematic Review and Meta-Analysis of Randomized Controlled Trials
by Dalal J. Alsharif, Farah J. Alsharif, Ghadeer S. Aljuraiban and Mahmoud M. A. Abulmeaty
Nutrients 2020, 12(10), 2968; https://0-doi-org.brum.beds.ac.uk/10.3390/nu12102968 - 28 Sep 2020
Cited by 25 | Viewed by 6749
Abstract
Enteral nutrition (EN) is considered the first feeding route for critically ill patients. However, adverse effects such as gastrointestinal complications limit its optimal provision, leading to inadequate energy and protein intake. We compared the clinical outcomes of supplemental parenteral nutrition added to EN [...] Read more.
Enteral nutrition (EN) is considered the first feeding route for critically ill patients. However, adverse effects such as gastrointestinal complications limit its optimal provision, leading to inadequate energy and protein intake. We compared the clinical outcomes of supplemental parenteral nutrition added to EN (SPN + EN) and EN alone in critically ill adults. Electronic databases restricted to full-text randomized controlled trials available in the English language and published from January 1990 to January 2019 were searched. The risk of bias was evaluated using the Jadad scale, and the meta-analysis was conducted using the MedCalc software. A total of five studies were eligible for inclusion in the systematic review and meta-analysis. Compared to EN alone, SPN + EN decreased the risk of nosocomial infections (relative risk (RR) = 0.733, p = 0.032) and intensive care unit (ICU) mortality (RR = 0.569, p = 0.030). No significant differences were observed between SPN + EN and EN in the length of hospital stay, hospital mortality, length of ICU stay, and duration of mechanical ventilation. In conclusion, when enteral feeding fails to fulfill the energy requirements in critically ill adult patients, SPN may be beneficial as it helps in decreasing nosocomial infections and ICU mortality, in addition to increasing energy and protein intakes with no negative effects on other clinical outcomes. Full article
(This article belongs to the Special Issue Nutrition and Metabolism in Critical Care)
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