In March 2024, organized by Chinese Society of Parenteral and Enteral Nutrition (CSPEN), experts in the fields of general surgery, critical care medicine, gastroenterology, geriatrics, clinical nutrition, clinical pharmacy and evidence-based medicine developed the guidelines for the clinical application of micronutrients in Chinese adult patients (2024 edition) on the basis of latest clinical evidence. The guidelines is of great value in guiding the clinical application of micronutrients. Here, we intended to interpret the guidelines, summarize the differences between domestic and foreign guidelines, and thus enhance our understanding.

Most hospitalized patients infected with coronavirus disease 2019 (COVID-19) are in severe or critical condition, and malnutrition is a key factor contributing to adverse outcomes. The basic principles of medical nutrition therapy have been determined in the recently released tenth edition of the National Diagnosis and Treatment Protocol. The principles have promoted nutritional risk assessment, emphasized the preferred method of enteral nutrition, and recommended the daily intake of calories at 25 to 30 kcal/kg and protein at > 1.2g/kg. Parenteral nutrition should be also added when necessary. Based on the above principles, Beijing Hospital has refined the medical nutrition therapy measures to facilitate the implementation in clinical practice, in order to improve healthcare quality and decrease the mortality in COVID-19 patients.

Objective:To study the association of frailty status with nutritional risk and the effect on clinical outcomes among elderly surgical inpatients.Methods:Elderly inpatients from the surgery department of Beijing Hospital were enrolled from January to June 2021. Frail scale and nutritional risk screening 2002 (NRS 2002) were used for frailty evaluation and nutrition risk screening. The influence of frailty and associated nutrition risk in elderly surgical inpatients was analyzed.Results:487 elderly surgical patients were included, of whom 131 cases were in the non-frailty group, 279 cases were in the pre-frailty group and 77 cases were in the frailty group, according to the Frail scale score. 146 cases were at nutritional risk, of whom 8 (6.1% of 131) were in the non-frailty group, 87 (31.2% of 279) in the pre-frailty group and 51 (66.2% of 77) were in the frailty group. According to univariate/multivariate logistic regression analysis of frailty in elderly surgical patients, a higher NRS 2002 score, older age, and the presence of multiple concurrent diseases (≥ 5) were significantly associated with frailty ( P < 0.001). The Frail scale score was positively correlated with NRS 2002 score ( r = 0.448, P < 0.01). Multiple comparisons showed that frailty had statistically significant effects on hospital stay and medical costs in elderly surgical patients ( P < 0.05). Conclusions:The prevalence of frailty is higher in elderly surgical patients, and the prevalence of nutritional risk increases with the progression of frailty. Frailty can lead to prolonged hospital stays and increased hospital costs in elderly surgical patients.

Objective:To explore the differences of renal dynamic imaging parameters between operation group and non-operation group in infants with severe hydronephrosis, so as to accumulate theoretical basis for diuretic renal scintigraphy to help the treatment decision making.Methods:A total of 107 infants (age: 3(2, 6) months; 90 males and 17 females) with severe hydronephrosis, who underwent diuretic renal scintigraphy between March 2018 and October 2021 in Shanxi Children′s Hospital were retrospectively reviewed. All patients were diagnosed with ureteropelvic junction obstruction and divided into operation group ( n=87) and no-operation group ( n=20). The differences of differential renal function (DRF), peak time, half-time and drainage curve between the two groups were compared with the independent-sample t test or χ2 test, and the correlation between the renal function of the affected side and the anteroposterior pelvic diameter (APD) was analyzed with Pearson correlation analysis. Results:The operation group included 17 patients with DRF<40%, 60 patients with DRF between 40%-55%, and 10 patients with DRF>55%(supernormal renal function). The 40%-55% was considered as normal DBF, and the rest were abnormal. Infants with abnormal renal function in the operation group ( n=27) were more than those in the non-operation group ( n=3), but there was no statistical difference ( χ2=2.07, P=0.150). The proportion of obstruction curve in the operation group (85.1%, 74/87) was significantly higher than that in the non-operation group (55.0%, 11/20; χ2=7.24, P=0.007). Compared with the non-operation group, the peak time of affected kidney in the operation group was significantly longer ((22.77±7.52) vs (15.26±10.29) min; t=3.78, P<0.001), as well as the peak time of contralateral kidney ((11.25±8.47) vs (6.65±5.75) min; t=2.30, P=0.023). There was a negative correlation between the DRF of the affected side and the APD ( r=-0.48, P<0.001). Conclusions:The DBF is mostly in the normal range in infants with severe hydronephrosis, and supernormal renal function is common. The previous operation indication (DRF<40%) is not suitable for the infants, and it needs to be analyzed combined with the type of curve and the APD determined by color Doppler ultrasound. The prolongation of contralateral renal peak time may be an important parameter for the surgical evaluation of severe hydronephrosis in infants.

Objective:To investigate the prevalence of malnutrition in elderly patients with neurological diseases and the of nutrition, and to explore their association with clinical outcomes.Methods:A retrospective study was conducted to analyze 566 elderly patients with neurological diseases in the database of the "National Multicenter Survey on the Dynamic Changes of Nutritional Status of Hospitalized Patients" by using the Global leadership Initiative on Malnutrition(GLIM)criteria and subjective global assessment(SGA). The two diagnostic tools for malnutrition were compared to explore the correlation between malnutrition and clinical outcomes.Results:Based on the GLIM criteria, 83 cases were diagnosed with malnutrition and the incidence of malnutrition was 14.66%(83/566), with 14.72%(48/326)in men and 14.58%(35/240)in women.Patients with moderate malnutrition accounted for 8.30%(47/566)and patients with severe malnutrition accounted for 6.36%(36/566). According to the SGA, the incidence of moderate malnutrition(SGA Grade B)was 15.55%(88/566), the incidence of severe malnutrition(SGA Grade C)was 1.94%(11/566), and all cases of malnutrition(SGA Grade B+ C)accounted for 17.49% of the participants(99/566). The total length of hospital stay was(15.46±6.49)days in the malnutrition group and(13.55±5.09)days in the non-malnutrition group, with a statistical difference between the two groups( t=-3.02, P<0.01). The body weight of the malnutrition group was significantly lower than non-malnutrition group[(52.0±8.5)kg vs.(65.2±9.6)kg, t=12.92, P<0.01]. There were also statistically significant differences in BMI(19.1±2.7 kg/m 2vs.23.9±2.6 kg/m 2, t=15.48, P<0.01), upper arm circumference[(22.3±2.5)cm vs.(28.3±3.9)cm, t=7.01, P<0.01], and lower leg circumference[(28.9±3.4)cm vs.(32.5±3.3)cm, t=6.81, P<0.01]between the two groups.Laboratory tests showed that there were significant differences in lymphocytes[(5.0±8.5)×10 9/L vs.(9.4±11.8)×10 9/L, t=3.61, P<0.01]and albumin[(38.5±4.4)g/L vs.(40.7±5.1)g/L, t=3.18, P<0.01]between the malnutrition group and the non-malnutrition group.The correlation between GLIM and SGA was good, and the consistency was reasonable(AUC=0.711). Conclusions:The incidence of malnutrition in elderly patients with neurological diseases is relatively high; The GLIM criteria are suitable for the diagnosis of malnutrition in elderly patients with neurological diseases, and the diagnostic results have a good correlation with those of SGA.Malnutrition is associated with anthropometric measurements, laboratory indicators, and clinical outcomes.

Objective:To study the correlation between nutritional status and length of hospital stay in patients with digestive disorders.Methods:The data were collected from the database of a multi-center investigation on the dynamic changes of nutritional status of hospitalized patients in China, a project led by the Geriatric Nutrition Support Group, Society of Parenteral and Enteral Nutrition, Chinese Medical Association. The enrolled patients were screened for malnutrition and possible sarcopenia using Global Leadership Initiative on Malnutrition criteria, and the dynamic changes of serum biochemical indexes during hospital stay and the effects of malnutrition and possible sarcopenia on the length and cost of hospital stay were analyzed.Results:A total of 1 180 patients were enrolled, with an average age of (56.3±16.1) years, the average height of (164.65±8.29) cm, and the average weight of (62.12±12.12) kg. There were significant differences in body weight, body mass index, calf circumference, lymphocyte count, triglyceride, hemoglobin, albumin and total protein between at discharge and at admission ( P<0.001). There might be a correlation between post-admission malnutrition and sarcopenia. There was neither significant difference in the proportion of patients with malnutrition at admission among different age groups ( P=0.438), nor in that at discharge among different age groups ( P=0.439). The proportion of patients with malnutrition showed no significant difference between subgroups with patients<65 years old and ≥ 65 years old, at admission and discharge ( P>0.05). However, comparison of the proportion of patients with sarcopenia between subgroups with patients<65 years old and ≥65 years old displayed significant differences at admission and discharge ( P<0.001), but not the comparison of the proportion of patients with possible sarcopenia ( P>0.05). The length of hospital stay in patients with malnutrition was significantly longer than that in patients without malnutrition [(13.22±6.24) days vs. (12.08±5.25) days, P<0.001]. The length of hospital stay of patients with and without sarcopenia was also significantly different [(12.87±5.93) days vs. (12.02±5.22) days, P<0.001). Patients with concurrent malnutrition and sarcopenia had longer hospital stay [(14.57±7.15) days vs. (12.07±5.22) days, P<0.001], and higher medical cost [(2.78±2.19) ten thousand Chinese Yuan vs. (2.24±2.33) ten thousand Chinese Yuan, P<0.05)] compared with those without concurrent malnutrition and sarcopenia. Conclusions:A large proportion of patients with digestive disorders were diagnosed with malnutrition and/or possible sarcopenia during hospitalization. There is possible correlation between malnutrition and possible sarcopenia, and both can lead to a longer hospital stay and higher medical cost.

Micronutrients (MNs), including vitamins and trace elements, play an indispensable role in human metabolism, immune function and other aspects. Due to the chronic microinflammation and long-term chemoradiotherapy, patients with malignant tumors often suffer from malnutrition, resulting in different degrees of MNs deficiency. In severe cases, MNs deficiency is closely related to the adverse clinical outcomes. Therefore, reasonable MNs supplementation is of great significance in improving the prognosis and quality of life of patients with tumors. Recently, multiple guidelines have made recommendations on the application of MN supplementation in various clinical settings, providing evidence for the standardized MN supplementation in patients with malignant tumors.

Objective:To analyze the correlation among nutritional status, sarcopenia and frailty in elderly inpatients with chronic cardiovascular disease.Methods:A cross-sectional study was conducted in a total of 147 patients aged 65-88 years old who were hospitalized for chronic cardiovascular disease between September 2018 and February 2019. Nutritional status was assessed by mini nutritional assessment short form (MNA-SF), frailty by FRAIL scale and sarcopenia by criteria from Asian Working Group for Sarcopenia: 2019 Consensus Update on Sarcopenia Diagnosis and Treatment. The prevalence and overlapping prevalence of nutritional status, frailty and sarcopenia were analyzed, as well as the influence of nutritional status on frailty and sarcopenia.Results:The mean age was 74.45 (range: 65-88). The prevalence was 25.9% (38/147) for risk of malnutrition, 1.4% (2/147) for malnutrition, 37.4% (55/147) for risk of sarcopenia, 6.8% (10/147) for sarcopenia, 55.8% (82/147) for pre-frailty and 10.2% (15/147) for frailty. When stratified by disease, the subgroup with chronic heart failure showed the highest prevalence of malnutrition risk, sarcopenia risk, sarcopenia and frailty (66.7%, 50%, 16.7% and 50.0%, respectively). The prevalence of sarcopenia risk and sarcopenia increased with age. Age was negatively correlated with calf circumference ( r = -0.219, P = 0.008), grip strength ( r = -0.307, P < 0.01) and walking speed ( r = -0.390, P < 0.01) and was positively correlated with the five times sit-to-stand test time ( r = 0.406, P < 0.01). The prevalence of frailty also increased with age and age was positively correlated with the FRAIL score ( r = 0.232, P = 0.005). As for stratification based on BMI, the majority (63.9%) patients were overweight or obese (BMI ≥ 24.0) and the prevalence of malnutrition risk in this subgroup was 20.2% (19/94). The prevalence of malnutrition risk in patients with normal BMI was 32.0% (16/50). The subgroup with BMI < 18.5 were either at malnutrition risk or with malnutrition. MNA-SF score was positively correlated with BMI ( r = 0.334, P < 0.01). The prevalence of sarcopenia risk and sarcopenia in patients with BMI ≥ 24.0 kg/m 2 was 23.4% (22/94) and 2.1% (2/94), that in normal BMI subgroup was 62.0% (31/50) and 14.0% (7/50), and that in BMI < 18.5 subgroup was 66.7% (2/3) and 33.3% (1/3). BMI was positively correlated with calf circumference ( r = 0.659, P < 0.01) and ASMI ( r = 0.367, P < 0.01). The overlapping prevalence of sarcopenia risk/sarcopenia and malnutrition risk/malnutrition was 13.6% (20/147), that of pre-frailty/frailty and malnutrition risk/malnutrition was 21.8% (32/147), and that of sarcopenia risk/sarcopenia and pre-frailty/frailty was 26.5% (39/147). The overlapping prevalence of sarcopenia risk/sarcopenia, malnutrition risk/malnutrition and pre-frailty/frailty was 10.9% (16/147). MNA-SF score was negatively correlated with FRAIL score ( r = -0.316, P < 0.01). The prevalence of pre-frailty/frailty in the malnutrition risk/malnutrition group was higher than that in the subgroup with normal nutritional status (80.0% vs. 60.7%, χ 2 = 4.808, P = 0.028). The prevalence of sarcopenia risk/sarcopenia in the malnutrition risk/malnutrition group tended to be higher than that in the subgroup with normal nutritional status (50.0% vs. 33.6%, χ 2 = 3.302, P = 0.069). Logistic regression analysis showed that the risk of pre-frailty/frailty was 2.585 (95% CI: 1.087 to 6.147) times higher in the malnutrition risk/malnutrition group. Conclusions:The prevalence and overlapping prevalence of malnutrition risk, pre-frailty and sarcopenia risk was high in the elderly inpatients hospitalized for chronic cardiovascular disease. Patients with malnutrition risk/malnutrition had a higher incidence of pre-frailty/frailty and required close attention.

Objective:To investigate the prevalence of malnutrition in hospitalized patients with lung cancer in China using the global leadership initiative on malnutrition (GLIM) criteria.Methods:A retrospective analysis was performed with 623 lung cancer patients selected from the national multi-center prospective investigation database in 2014. The diagnosis of malnutrition was according to GLIM criteria with muscle mass reduction not included. The prevalence of malnutrition in patients with lung cancer was investigated and the correlation between malnutrition diagnosis per GLIM criteria and anthropometry as well as laboratory indexes was explored.Results:Among the 623 lung cancer patients, 33.5% (209) were at nutritional risk as per Nutritional Risk Screening 2002, 17.8% (111) were malnourished as per GLIM criteria. There were significant differences in age, body weight, body mass index, arm circumference, leg circumference, grip strength, hemoglobin, albumin, total protein and prealbumin between malnutrition and non-malnutrition groups as diagnosed with GLIM criteria ( P<0.05). Conclusions:The nutritional risk and malnutrition prevalence in lung cancer patients are relatively high. The nutritional risk screening of lung cancer patients should be standardized and the GLIM criteria can be used for the diagnosis of malnutrition.

The purpose of value-based healthcare is to effectively control medical costs on the basis of comprehensively improved healthcare quality, which is the key focus of medical system reform in China. Improving information system framework, establishing scientific evaluation methods and transforming medical insurance payment methods are the impetus for value-based healthcare practice in China. "Screening, assessment and intervention" is the critical step in standardized medical nutrition management. In line with the connotation of value-based healthcare, nutritional risk screening aims to improve clinical outcomes. The diagnosis of malnutrition per the Global Leadership Initiative on Malnutrition (GLIM) criteria enables the inclusion into Diagnosis Related Groups (DRGs). Oral nutritional supplement is the preferred medical nutrition treatment for patients at nutritional risk or with malnutrition and insufficient food intake. Standardized application can reduce weight loss, improve clinical outcomes, save medical costs and improve the health and survival of malnourished elderly patients at a lower cost, exemplifying the value-based healthcare model.