Protein and energy intake in intensive care unit survivors during the first year of recovery:A descriptive cohort study

AbstractBackground: Many intensive care unit (ICU) survivors suffer long‐term health issues that affect their quality of life. Nutrition inadequacy can limit their rehabilitation potential. This study investigates nutrition intake and support during ICU admission and recovery.Methods: In this prospective cohort study, 81 adult ICU patients with stays ≥48 hwere included. Data on dietary intake, feeding strategies, baseline and ICUcharacteristics, and 1‐year outcomes (physical health and readmission rates) werecollected. The number of patients achieving 1.2 gram per kilogram per day of protein and 25 kilocalories per kilogram per day at 3 months, 6 months, and 12 months after ICU admission was recorded. The impact of dietary supplementation during the year was assessed. Baseline characteristics, intake barriers, and rehabilitation's influence on nutrition intake at 12 months were evaluated, along with the effect of inadequate intake on outcomes.Results: After 12 months, only 10% of 60 patients achieved 1.2 g/kg/day proteinintake, whereas 28% reached the advised 25 kcal/kg/day energy target. Supplementary feeding significantly increased protein intake at 3, 6, and 12 months (P = 0.003, P = 0.012, and P = 0.033, respectively) and energy intake at 3 months (P = 0.003). A positive relation was found between female sex and energy intake at 12 months after ICU admission (β = 4.145; P = 0.043) and taste issues were independently associated with higher protein intake (β = 0.363; P = 0.036). However, achieving upper‐quartile protein or energy intake did not translate into improved physical health outcomes.Conclusion: Continuous and improved nutrition care is urgently needed to supportpatients in reaching nutrition adequacy

Long-term health-related quality of life, healthcare utilisation and back-to-work activities in intensive care unit survivors:Prospective confirmatory study from the Frisian aftercare cohort

PURPOSE: More substantial information on recovery after Intensive Care Unit (ICU) admission is urgently needed. In a previous retrospective study, the proportion of non-recovery patients was 44%. The aim of this prospective follow-up study was to evaluate changes in Health-Related Quality of Life (HRQoL) in the first year after ICU-admission. METHODS: Long-stay adult ICU-patients (≥ 48 hours) were included. HRQoL was evaluated with the Dutch translation of the RAND-36 item Health Survey (RAND-36) at baseline via proxy measurement, and at three, six, and twelve months after ICU admission. Subsequently, the relation between physical functioning, healthcare utilisation, and work activities was explored. RESULTS: A total of 81 patients were included in this study. Fifty-five percent of patients did not meet criteria for full recovery and were allocated to the Non Recovery (NR)-group (Physical Functioning domain-score: 35 [15-55]). Baseline physical HRQoL differed significantly between the Recovery (R) and NR-group. Patients in the NR-group received home care more often and had higher healthcare utilisation (44 versus 17% in the first three months post-ICU, p = 0.013). Only fourteen percent of NR-patients were able to participate in work activities. Moreover, NR-patients persistently showed impaired overall HRQoL throughout the year after critical illness. CONCLUSIONS: Limited recovery in ICU survivors is reflected in overall impaired HRQoL, as well as in far-reaching consequences for patients' healthcare needs and their ability to reintegrate into society. In our study, baseline HRQoL appeared to be an important predictor of long-term outcomes, but not Clinical Frailty Scale (CFS) score. And, (proxy-derived) HRQoL may help to identify patients at risk of long-term non-recovery

Measuring Muscle Mass and Strength in Obesity:A Review of Various Methods

Lower muscle mass in populations with obesity is associated obesity-related diseases like hypertension and type 2 diabetes mellitus. Bariatric surgery leads to sustained weight loss. During the weight reduction, loss of muscle should be minimized. Thus reliable quantification of muscle mass is much needed and therefore the also the need for validated methods. Imaging methods, magnetic resonance imaging and computed tomography scan, have been the gold standard for many years. However, these methods are costly and have limitations such as the maximum weight. Dual-energy X-ray absorptiometry is currently the most used alternative. Other, less expensive methods are very limited in their validation in populations with morbid obesity. This narrative review summarizes the current knowledge regarding measuring muscle mass and strength in obesity

Dietary Inflammatory Index and clinical outcome measures in adults with moderate to severe asthma

BACKGROUND: Diet is increasingly recognized as a modifiable factor in lung health, predominantly due to the immunomodulatory effects of nutrients. The Dietary Inflammatory Index (DII) is a score developed to express the inflammatory potential of a diet.OBJECTIVE: We aimed to assess the association of the DII and food groups, with clinical, functional and inflammatory asthma outcomes in adults with asthma.METHODS: Patients with moderate to severe asthma were included in this cross-sectional study between June 2019 and October 2021, and completed a 3-day food diary, to calculate the DII and intake of food groups (i.e. fruits, whole grains, processed meats and sugar-sweetened beverages). Functional outcomes included pulmonary function tests and the 6-minute walking distance, while clinical outcomes were assessed using questionnaires on asthma control, quality of life, and healthcare utilization. Inflammatory markers were exhaled nitric oxide and blood leukocytes, eosinophils and interleukin-6. Multivariable regression analyses were used to examine the association of DII and food groups with asthma outcomes.RESULTS: A total of 109 patients participated (35% male, mean±SD age 51.8 ± 14.2 years, BMI 27.4 ± 5.3 kg/m 2). Overall, 62% had a DII score &gt;0, indicating a pro-inflammatory diet, which was not related to asthma severity. A more pro-inflammatory diet was consistently associated to lower FVC (%pred), but inconsistent results were observed with respect to airway obstruction. Neither the DII nor food groups were associated with clinical outcomes. Except for higher levels of exhaled nitric oxide in relation to an anti-inflammatory diet, we found no associations between inflammatory markers and the DII. CONCLUSION: Results from this cross-sectional study among patients with moderate to severe asthma do not support the hypothesis that a pro-inflammatory diet is associated with worse asthma outcomes, although limitations in study design and dietary intake estimation should be considered. Future well-designed experimental studies are needed to assess whether targeting the inflammatory potential of diet could lead to better outcomes in adults with asthma.</p

Muscle Function in Moderate to Severe Asthma:Association With Clinical Outcomes and Inflammatory Markers

BackgroundPatients with severe asthma have been shown to have low muscle mass, but the clinical consequences are unknown.ObjectiveIn a clinical cohort of patients with moderate to severe asthma, we aimed to assess muscle mass and strength and their relation with functional and clinical outcomes, as well as with systemic inflammatory markers.MethodsMuscle mass and strength were assessed by the fat-free mass index (FFMI), creatinine excretion in a 24-hour urine sample, and handgrip strength test. Functional outcomes included pulmonary function tests and the 6-minute walking distance, whereas clinical outcomes were assessed with questionnaires on asthma control, quality of life, and health care use. Associations of muscle mass and strength with asthma outcomes were assessed with multivariable regression analyses.ResultsA total of 114 patients participated (36% male; mean age, 51.9 ± 14.4 years; body mass index, 27.7 ± 5.7 kg/m2). According to predefined criteria, 16% had a low FFMI and 8% a low urinary creatinine excretion, which did not differ between categories of asthma severity. Both lower FFMI and urinary creatinine excretion were associated with lower values of FEV1 and 6-minute walking distance, whereas a lower handgrip strength was related to worse asthma control, poorer quality of life, and a higher probability of emergency visits (all P &lt; .05). Except for higher leukocytes in relation to lower FFMI, we did not find associations between systemic inflammatory markers and muscle function.ConclusionsThis study demonstrates that low muscle mass is prevalent in patients with moderate to severe asthma and, along with low muscle strength, is associated with poorer clinical and functional outcomes. Our results encourage longitudinal studies into muscle function as a potential target for treatment to improve asthma outcomes

Dietary Inflammatory Index and clinical outcome measures in adults with moderate to severe asthma

BACKGROUND: Diet is increasingly recognized as a modifiable factor in lung health, predominantly due to the immunomodulatory effects of nutrients. The Dietary Inflammatory Index (DII) is a score developed to express the inflammatory potential of a diet.OBJECTIVE: We aimed to assess the association of the DII and food groups, with clinical, functional and inflammatory asthma outcomes in adults with asthma.METHODS: Patients with moderate to severe asthma were included in this cross-sectional study between June 2019 and October 2021, and completed a 3-day food diary, to calculate the DII and intake of food groups (i.e. fruits, whole grains, processed meats and sugar-sweetened beverages). Functional outcomes included pulmonary function tests and the 6-minute walking distance, while clinical outcomes were assessed using questionnaires on asthma control, quality of life, and healthcare utilization. Inflammatory markers were exhaled nitric oxide and blood leukocytes, eosinophils and interleukin-6. Multivariable regression analyses were used to examine the association of DII and food groups with asthma outcomes.RESULTS: A total of 109 patients participated (35% male, mean±SD age 51.8 ± 14.2 years, BMI 27.4 ± 5.3 kg/m 2). Overall, 62% had a DII score &gt;0, indicating a pro-inflammatory diet, which was not related to asthma severity. A more pro-inflammatory diet was consistently associated to lower FVC (%pred), but inconsistent results were observed with respect to airway obstruction. Neither the DII nor food groups were associated with clinical outcomes. Except for higher levels of exhaled nitric oxide in relation to an anti-inflammatory diet, we found no associations between inflammatory markers and the DII. CONCLUSION: Results from this cross-sectional study among patients with moderate to severe asthma do not support the hypothesis that a pro-inflammatory diet is associated with worse asthma outcomes, although limitations in study design and dietary intake estimation should be considered. Future well-designed experimental studies are needed to assess whether targeting the inflammatory potential of diet could lead to better outcomes in adults with asthma.</p