Roles, responsibilities, and opportunities for the nutrition support physician working with adults: A critical review.

The dual burden of undernutrition and overnutrition requires a greater understanding and commitment to physician training and specialization in nutrition support. Despite the significant healthcare need and existence of organizations focused on nutrition support such as the American Society for Parenteral and Enteral Nutrition (ASPEN), physician involvement in the nutrition care of high-risk patients remains low. In an ASPEN survey of members, inadequate training among physicians was reported along with significant barriers to involvement in nutrition support, such as insufficient protected time, reduced reimbursement and financial support, inadequate support from administrators or supervisors, as well as a nationwide reduction in number of nutrition support teams.

Clinical and Gut Microbiome Characteristics of Medically Complex Patients Receiving Blenderized Tube Feeds vs. Standard Enteral Feeds.

Diet is known to influence the composition of the gut microbiome. For patients who require enteral feeding, there has been a growing popularity of using blenderized tube feeds (BTFs) as an alternative to standard enteral formula (SEF). There is limited literature exploring the impact of BTFs on the gut microbiome.

Sifting Through the Noise: Identifying Core Fundamentals of Healthy Eating Early in the Life Cycle.

Purpose Of Review: Optimal nutrition is important across all age groups. However, nutrition provision during early years of life is more crucial and any aberrations in this period could lead to long lasting consequences. The first 1000 days starting from conception to the second birthday is the period of maximum growth velocity and brain growth and suboptimal nutrition in this period should be avoided at all cost.

Evolving nutrition therapy in cystic fibrosis: Adapting to the CFTR modulator era.

Cystic fibrosis transmembrane regulator (CFTR)-directed therapies, such as modulators, have transformed the medical management of people with CF, resulting in better lung function, weight, and body mass index in recent years. With improved nutrition status in people on CFTR modulators, the emphasis on a high-energy, high-fat diet (the legacy CF diet) is declining, with an increased focus on a healthy diet. The increased survival and median predicted age of people with CF have created a need for more attention to metabolic diseases, including hypertension, dyslipidemia, and cardiovascular diseases.

Impact of Elexacaftor/Tezacaftor/Ivacaftor on Fecal Elastase-1 in Children With Cystic Fibrosis.

Background: Prior studies have documented improvement in pancreatic status after ivacaftor and lumacaftor/ivacaftor in a small number of patients with cystic fibrosis (CF). There is paucity of data with similar improvement after initiation of elexacaftor/tezacaftor/ivacaftor (ETI).

Methods: In this cross-sectional study, we retrospectively reviewed the change in fecal elastase-1 (FE-1) at least 6 months after initiation of ETI in children less than 12 years of age.

State-of-the-art review of blenderized diets-Status and future directions.

This state-of-the-art review was produced by a multidisciplinary team composed of pediatric gastroenterology and nutrition healthcare providers to provide a comprehensive overview of the use of blenderized tube feeds (BTFs). The team developed 12 vital questions to address gaps in the current understanding and practice of using BTFs, then performed a comprehensive search of literature published between 2000 and 2023 using PubMed, MEDLINE, Embase databases, and an individual search of references. There was a scarcity of well-designed randomized clinical trials, and most of the studies were prospective or retrospective observational reports from heterogeneous patient demographics, varieties of BTFs, and medical conditions.

Hospitalization Trends and Healthcare Resource Utilization for Fecal Impactions in Pediatric Patients with Functional Constipation.

: To analyze the clinical characteristics, trends in hospitalization, and healthcare resource utilization of pediatric patients with fecal impaction. : We utilized the Healthcare Cost and Utilization Project (HCUP) databases, including the National Inpatient Sample (NIS) and the Kids Inpatient Database (KID) datasets from 2011 to 2019, to include all hospitalizations of patients up to 18 years of age with a primary diagnosis of (1) fecal impaction or (2) a primary diagnosis of abdominal pain or constipation with a secondary diagnosis of fecal impaction. The study analyzed various comorbid factors and clinical characteristics of these patients.

Utility of Aprepitant in the Management of Pediatric Patients with Cyclical Vomiting Syndrome.

: Cyclical vomiting syndrome (CVS) is a recurrent debilitating illness characterized by intense episodes of nausea and emesis with widely varied pharmacological management across the country. Aprepitant is now increasingly used in patients with CVS. The impact of aprepitant as an abortive therapy in the readmission of pediatric patients with CVS is currently unknown.

Case Report: A delicate equilibrium of exocrine pancreatic recovery and hepatotoxicity with elexacaftor/tezacaftor/ivacaftor therapy in a pediatric patient with cystic fibrosis.

This case report presents a comprehensive evaluation of the complex balance of therapeutic benefits and potential risks associated with the cystic fibrosis transmembrane conductance regulator (CFTR) modulator elexacaftor/tezacaftor/ivacaftor (ETI) therapy in managing an eight-year-old male with cystic fibrosis (CF) and exocrine pancreatic insufficiency (EPI). While ETI therapy significantly enhanced exocrine pancreatic function, it led to hepatotoxicity, necessitating therapy discontinuation. Attempts to restart ETI at reduced doses were unsuccessful due to persistent hepatic dysfunction.

Collaboration between registered dietitians and gastroenterologists in cystic fibrosis care: Results of an international cross-sectional survey.

Background: Collaboration between registered dietitians and gastroenterologists has not been evaluated in cystic fibrosis (CF). We surveyed registered dietitians and gastroenterologists regarding the current participation of gastroenterologists in CF centers and identified possible areas to enhance partnership between the two disciplines.

Methods: An anonymous online survey was distributed targeting registered dietitians and gastroenterologists involved in CF care through three international listservs (CF Nutrition, CF DIGEST, and PEDGI) over a 6-week period.

Obstructive Sleep Apnea Is Associated with Worsened Hospital Outcomes in Children Hospitalized with Asthma.

Background: Studies have shown a bidirectional relationship between asthma and obstructive sleep apnea (OSA). However, there is a paucity of national-level data evaluating the impact of OSA on hospital outcomes in pediatric hospitalizations for asthma.

Methods: We analyzed the National Inpatient Sample and Kids Inpatient Database to include all pediatric hospitalizations with a primary diagnosis of asthma between 2003-2016.

Early detection of hepatobiliary involvement in cystic fibrosis: Biomarkers, radiologic methods, and genetic influences.

Cystic fibrosis-related hepatobiliary involvement (CFHBI) is a term used to describe a spectrum of hepatobiliary involvement ranging from a transient elevation of transaminase levels to advanced cystic fibrosis-associated liver disease (aCFLD). While CFHBI is common among people with cystic fibrosis (PwCF), aCFLD is rare impacting only approximately 5%-10% of the CF population. After respiratory/cardiorespiratory issues and transplant-related complications, aCFLD is now the 4th leading cause of mortality among PwCF.

From the kitchen to the medicine cabinet: Examples of functional herbs and spices.

In many cultures, "food as medicine" has existed for centuries as the foundation of health. It is a practice built on the knowledge that food and diet play important roles in disease prevention and management. Foods possessing therapeutic properties are often referred to as functional foods.

"Feed a Cold, Starve a Fever?" A Review of Nutritional Strategies in the Setting of Bacterial Versus Viral Infections.

Purpose Of Review: Some data, mostly originally derived from animal studies, suggest that low glucose intake is protective in bacterial sepsis but detrimental in overwhelming viral infections. This has been interpreted into a broad belief that different forms of sepsis may potentially require different nutritional management strategies. There are a few mechanistic differences between the host interactions with virus and bacteria which can explain why there may be opposing responses to macronutrient and micronutrient during the infected state.

Cannabis use and cyclic vomiting syndrome.

None.

Impact of Erythromycin as a Prokinetic on the Gut Microbiome in Children with Feeding Intolerance-A Pilot Study.

Background: Studies have demonstrated that the gut microbiome changes upon exposure to systemic antibiotics. There is a paucity of literature regarding impact on the gut microbiome by long-term usage of erythromycin ethyl succinate (EES) when utilized as a prokinetic.

Methods: Stool samples from pediatric patients with feeding intolerance who received EES ( = 8) as a prokinetic were analyzed for both bacteriome and mycobiome.

Exocrine Pancreatic Insufficiency in Children - Challenges in Management.

Cystic fibrosis (CF) is the leading etiology for exocrine pancreatic insufficiency (EPI) in children, followed by chronic pancreatitis, Shwachman-Diamond syndrome, and other genetic disorders. Management of EPI in children poses several unique challenges such as difficulties in early recognition, lack of widespread availability of diagnostic tests and limited number of pediatric-specific pancreatic centers. Pancreatic enzyme replacement therapy is the cornerstone of EPI management and in young children difficulties in administering pancreatic enzymes are frequently encountered.